Blue Access for Employers

How BlueEdgeSM HCA Works


Take a look at these examples of how BlueEdge HCA can work.

Jane: a single parent with two children and family coverage with a health care account
John: individual coverage with a health care account
Jennifer and Bill: a married couple with a new baby and family coverage with a health care account


Jane

Jane has BlueEdge HCA family coverage with a Health Care Account funded by her employer. She is a single parent with two young children, Sarah and Zach. Jane took advantage of the online member resources available to her as a BlueEdge HCA member. Using Blue Access for Members, Blue Cross and Blue Shield of New Mexico's secure online service, she regularly checks her Health Care Account balance, Explanation of Benefits, and remaining deductible. She also reads about her own health conditions through Personal Health Manager.

Year One

Jane's annual family Health Care Account = $1,500
Jane's annual family deductible = $3,000 (individual deductible = $1,500)

Jane's children had their annual wellness visits with the pediatrician, including physicals and preventive care tests.
$470 was paid by the PPO preventive care benefit.

Zach had several visits to the pediatrician for strep throat.
$240 was paid by the Health Care Account and applied to his deductible.

Sarah was tested for allergies.
$120 was paid by the Health Care Account and applied to her deductible.

Jane saw a specialist for stomach problems and had a diagnostic procedure.
$900 was paid by the Health Care Account and applied to her deductible.

All of the family's health care services were paid by the preventive care benefit or the Health Care Account. Jane did not have any out-of-pocket expenses. At the end of the year, $240 remained in her Health Care Account. The balance rolled over and was added to the next year's employer contribution.

Year Two

Jane's annual family Health Care Account = $1,740 ($1500 + $240)

The children had their annual wellness visits to the pediatrician and Jane had a check up with her internist.
$570 was paid by the PPO preventive care benefit.

Zach had several visits to the pediatrician for an ear infection and Jane saw the specialist for a follow-up visit and lab test.
$670 was paid by the Health Care Account and applied to their deductibles.

Jane did not pay for any of the health care services her family received. At the end of the second year, $1,070 remained in her Health Care Account. The balance rolled over and was added to the next year's amount.

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John

John has BlueEdge HCA individual coverage with a Health Care Account funded by his employer. While he is generally in good health, he has asthma that requires allergy testing and treatment. With the online resources available to BlueEdge HCA members, he used Personal Health Manager's health information to research asthma. He also tracked his Health Care Account and deductible balance.

Year One

John's annual Health Care Account = $750
John's annual deductible = $1, 500

John had a physical and preventive care lab tests.
$200 was paid by the PPO preventive care benefit.

He saw an allergist and had allergy tests.
$175 was paid by the Health Care Account and applied to the deductible.

He underwent emergency surgery for appendicitis.
Of the $6,000 bill, $575 was paid by the remaining Health Care Account and applied to the deductible. John paid $750 of the remaining deductible, leaving $4,675. The PPO benefits paid 80 percent ($3,740) and John paid his 20 percent coinsurance ($935).

John had used all of his Health Care Account, so there was no roll over to the next year.

Year Two

Health Care Account = $750

John had an annual physical and related lab tests.
$200 was paid by the PPO preventive care benefit.

He saw the allergist several times.
$400 was paid by the Health Care Account and applied to the deductible.

All of John's health care services were paid by the preventive care benefit or the Health Care Account. He did not have any out-of-pocket expenses. At the end of the year, $350 remained in his Health Care Account. The balance rolled over and was added to the next year's employer contribution.

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Jennifer and Bill

Jennifer and Bill have BlueEdge HCA family coverage through Bill's employer. Their son was born during the first year of coverage. Jennifer found practical prenatal care information online through Personal Health Manager available on Blue Access for Members. After taking the online Health Risk Assessment, Bill discovered he was at some risk for developing heart disease. He spoke with his doctor and then modified his diet and began exercising using the information he found on the site. Bill also saw a dermatologist and the baby had ear infections.

Year One

Bill's annual family Health Care Account = $1,500
Bill's annual family deductible = $3,000 (individual deductible = $1,500)

Jennifer and Bill each had a physical exam and preventive care lab tests; the baby received well-child care and immunizations.
$1,540 was paid by the PPO preventive care benefit.

Jennifer had her first prenatal visit.
$320 was paid by the Health Care Account and applied to her deductible.

Jennifer received all of her prenatal and maternity care.
Of the $9,600 bill, $1,180 was paid by the remaining Health Care Account and applied to Jennifer's deductible, satisfying her $1,500 individual deductible. Of the remaining $8,420, the PPO benefits paid 80 percent ($6,736) and Jennifer and Bill paid their 20 percent coinsurance ($1,684).

Bill saw a dermatologist and the baby saw the pediatrician for an ear infection.
$480 was paid by Jennifer and Bill, which was applied to Bill's and the baby's deductibles.

Jennifer and Bill had used all of their Health Care Account, so there was no roll over to the next year.

Year Two

Jennifer and Bill had annual physicals and related lab tests, and Jennifer had a mammogram. The baby had well-child care visits to the pediatrician and received immunizations.
$1,380 was paid by the PPO preventive care benefit.No funds were deducted from Bill's HCA.

The baby saw the pediatrician for a cold and ear infection and Bill went to the dermatologist.
$610 was paid by the Health Care Account and applied to their deductibles.

All of the family's health care services were paid by the preventive care benefit or the Health Care Account. Jennifer and Bill did not have any out-of-pocket expenses. At the end of the year, $890 remained in the Health Care Account. The balance rolled over and was added to the next year's employer contribution.

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Learn More About BlueEdge HCA

Overview
Benefit Information
Spending Account and the Deductible
BlueEdge HCA FAQs
Common FAQs

 

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